High-Cost Patients with Diabetes Incur Higher Annual Healthcare Costs

San Francisco—Results of a new study show that patients with type 2 diabetes, who are considered high cost, accrue more than $50,000 on average in total healthcare costs each year compared to patients with type 2 diabetes who are considered not high cost. These high-cost patients also had significantly more comorbidities, such as obesity, renal impairment, hypertension, chronic pulmonary disease, congestive heart failure, liver disease, and cardiovascular disease. This study was presented at a poster session at the AMCP meeting and the poster was titled The High-Cost Type 2 Diabetes Mellitus Patient: Findings from a United States Managed Care Population.

The prevalence of diabetes in the United States is expected to more than double, from 5.6% in 2005 to 12.0% in 2050. The total economic burden of diabetes is substantial, with recent estimates indicating that it accounts for $174 billion annually.

The current study was done to document the actual healthcare costs incurred by payers for a population of patients with type 2 diabetes over a 1-year period and to determine factors that accounted for the higher annual costs of these patients.

The study also compared healthcare costs between patients with type 2 diabetes identified as high cost (those with all-cause costs in the 1-year follow-up that were in the 90th percentile or greater) and not high cost (those with all-cause costs in the 1-year follow-up that were below the 90th percentile).

Using administrative claims from 95 managed care health plans obtained through a commercial database, the investigators retrospectively examined data for patients with at least 2 diagnoses of type 2 diabetes during the study period (July 2005-June 2010). The date of the first diagnosis defined the index date. Patients eligible for inclusion in the study also were required to have at least 1 year of continuous plan enrollment post-index date.

Patients were then grouped into high-cost patients (n=172,004) and not high-cost patients (n=1,548,037). All-cause healthcare utilization total costs for each cohort were calculated based on aggregate costs over a 1-year follow-up period for inpatient, skilled nursing facility, emergency department, outpatient hospital, office visits, laboratory, other outpatient care, and pharmacy services, and the total for all of these services. Diabetes-related healthcare utilization and costs included all inpatient visits with a primary discharge diagnosis of diabetes, outpatient and laboratory services with a primary or secondary diagnosis of diabetes, and medications specific to treating diabetes.

Overall, the high-cost and not high-cost patients were comparable in age, sex, geographical region, type of health plan, and payer distribution. Charlson Comorbidity Index (CCI) score was significantly higher in the high-cost patients compared with the not high-cost patients, and high-cost patients were significantly more likely to have a diagnosis of renal impairment, obesity, and hypertension. Also, high-cost patients were significantly more likely to receive insulin.

During the 1-year of follow-up, the study found that all-cause related healthcare costs and diabetes-related healthcare costs were on average $50,000 and $4014, respectively, higher for the high-cost patients compared with the not high-cost patients. Nearly 75% (n=127,553) of high-cost patients had at least 1 inpatient stay compared with 11% (n=166,729) of not high-cost patients.

When looking at patient factors that accounted for patients being identified as a high-cost patient, CCI score of >2 was the strongest predictor, followed by a diagnosis of obesity, renal impairment, and insulin use.

Based on the results of the study, the investigators say that “further research is needed to explore potential interventions to reduce the likelihood that a patient becomes high cost.”

This study was supported by Bristol-Myers Squibb and AstraZeneca.